combination chemotherapy plus radiation therapy in treating adult patients with brain cancer

Conditions: Brain and Central Nervous System Tumors

Summary: rationale: drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. radiation therapy uses high-energy x-rays to damage tumor cells. combining more than one drug and combining chemotherapy with radiation therapy may kill more tumor cells. purpose: phase ii trial to study the effectiveness of combination chemotherapy followed by radiation therapy in treating adult patients with brain cancer.

objectives: * determine the complete and partial response rate of patients with adult medulloblastoma, primitive neuroectodermal tumor, or disseminated ependymoma treated with preradiation combination chemotherapy. * determine the progression free survival and overall survival of these adult patients treated with combination chemotherapy followed by craniospinal radiation. * determine the toxic effects associated with this treatment in these patients. outline: patients receive cisplatin iv over 6 hours, etoposide iv, and vincristine iv over 1-2 minutes on day 1; etoposide iv and cyclophosphamide iv over 1-2 hours on days 2-3; filgrastim (g-csf) subcutaneously (sc) on days 4-13; and vincristine iv over 1-2 minutes on day 15. treatment repeats every 42 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. within 4-6 weeks after the last chemotherapy course, patients undergo radiotherapy 5 days a week for 6 to 7 weeks. patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually for 5-10 years. projected accrual: a total of 33 patients will be accrued for this study within 3 years.

Eligibility criteria:
disease characteristics: * histologically confirmed central nervous system cancer including: * medulloblastoma with either local residual disease of greater than 1 cm\^2 on mri following resection or evidence of metastases (m1-4) * other primitive neuroectodermal tumors * ependymoma with evidence of subarachnoid metastases * must have less than 1 cm of midline shift or no acute elevated intercranial pressure patient characteristics: age: * 18 and over performance status: * ecog 0-2 life expectancy: * not specified hematopoietic: * wbc greater than 4,000/mm\^3 * platelet count greater than 125,000/mm\^3 * hemoglobin greater than 10 g/dl * no preexisting hematologic condition that would increase toxicity or limit ability to comply with evaluations and follow-up hepatic: * bilirubin less than 2 times upper limit of normal (uln) * sgot less than 2 times uln * alkaline phosphatase less than 2 times uln * no preexisting hepatic condition that would increase toxicity or limit ability to comply with evaluations and follow-up renal: * creatinine greater than 70 ml/min * no preexisting renal condition that would increase toxicity or limit ability to comply with evaluations and follow-up pulmonary: * no history of significant pulmonary disease or, if there is preexisting pulmonary disease, then dlco greater than 60% of predicted * no preexisting pulmonary condition that would increase toxicity or limit ability to comply with evaluations and follow-up other: * no preexisting psychiatric condition that would increase toxicity or limit ability to comply with evaluations and follow-up * no prior or concurrent malignancies within the past 5 years except curatively treated carcinoma in situ of the cervix or basal cell or squamous cell skin cancer * not pregnant or nursing * fertile patients must use effective contraception prior concurrent therapy: biologic therapy: * not specified chemotherapy: * no prior chemotherapy endocrine therapy: * no increasing doses of steroids for intracranial disease within 3 days of registration radiotherapy: * no prior radiotherapy surgery: * 10-28 days since prior surgical resection or * at least 5 days since prior biopsy

Keywords: adult medulloblastoma adult anaplastic ependymoma adult ependymoma adult supratentorial primitive neuroectodermal tumor (pnet)